Trigeminal Neuropathy

(Cranial nerve V)

Intra-axial (pons)


Neoplastic Demyelination


Distal pontine dorsolateral infarction may cause ipsi-lateral facial anesthesia, because the lesion damages the entering and descending fibers of the fifth nerve

E.g., pontine glioma, metastases

E.g., multiple sclerosis; an attack of numbness of one side of the face in a young person, occasionally after local anesthesia for dental work, is quite a common symptom of multiple sclerosis

- Congenital, e.g., Chiari malformations

- Secondary, e.g., trauma, ischemic necrosis, high cervical intramedullary tumor

Cerebellopontine angle

Acoustic neurinoma

Meningioma Usually associated with bony hyperostosis and/or cal cification within the lesion

Ectodermal inclusions E.g., epidermoid, dermoid


Trigeminal neurinoma


Lesions at the petrous tip

Petrositis E.g., diffuse inflammation of the petrous bone from mastoiditis or middle ear infection. This causes severe ear pain and a combination of lesions in nerves VI, VII, VIII, and V, and is known as Gradenigo's syndrome Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license.

Cavernous sinus/orbital fissure

Severe trauma

Metastatic carcinomas

Cavernous sinus thrombosis


Tumors arising in the orbit and optic foramina


Diabetic vascular neuropathy

Trigeminal neuralgia Acute herpes zoster

Systemic lupus erythe-matosus


Progressive systemic sclerosis

Sjögren's syndrome Amyloidosis

E.g., carcinomas of the nasopharynx or the paranasal sinuses

Dilatation of the intracavernous portion of the carotid artery at the posterior end of the sinus may irritate the ophthalmic division of the fifth nerve

E.g., meningioma 40%; hemangiomas 10%; pseudotumor 5%; glioma 5%; carcinoma of the lacrimal duct, neurofibroma, epidermoid, fibrous dysplasia of bone, sarcoma, melanoma, lipoma, Tolosa-Hunt syndrome, Hand-Schüller-Christian disease 40%

In the elderly, the virus has a predilection for the first division of the seventh nerve

Vasculitic trigeminal neuropathy

Isolated trigeminal neuropathy may be the presenting sign in 10% of patients with neurological manifestations of scleroderma and occurs in 4-5% of all patients with scleroderma

Fibrosis with nerve entrapment is the likely cause of trigeminal and other cranial neuropathies

Vasculitic trigeminal neuropathy

Peripheral neuropathy with involvement of the fifth cranial nerve

Arsenic neuropathy Peripheral and trigeminal neuropathy

Trigeminal sensory neuropathy

A slowly progressing unilateral or bilateral facial numbness or paresthesia, thought to be caused by vasculitis or fibrosis of the gasserian ganglion; most frequently leads to the diagnosis of an underlying connective tissue disease, e.g., Sjogren's syndrome, systemic lupus erythematosus, and dermatomyositis

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